Effectiveness and Safety of Combined Therapy with Oral Minoxidil, Oral Dutasteride, and Mesotherapy with Dutasteride in Real Clinical Practice
by
, and
César Daniel Villarreal-Villarreal
1,2
,
Estefanía Boland-Rodriguez
1,
Carolina Gonzalez-Macias
2,
Juan Francisco Molina-de la Garza
1,
David Saceda-Corralo
3,4,5,*
and
Sergio Vano-Galvan
3,4,6 1
CEDAVI Derma Experts, Hair Restoration Unit, Calzada San Pedro 204, Col. del Valle, San Pedro Garza Garcia 66220, Mexico
2
Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Av. Ignacio Morones Prieto 3000, Sertoma, Monterrey 64710, Mexico
3
Servicio de Dermatología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
4
Trichology Unit, Grupo de Dermatologia Pedro Jaén, C. del Cinca 30, Chamartín, 28002 Madrid, Spain
5
Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, IRYCIS, 28801 Madrid, Spain
6
Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, 28034 Madrid, Spain
*
Author to whom correspondence should be addressed.
J. Aesthetic Med. 2025, 1(2), 6; https://doi.org/10.3390/jaestheticmed1020006
Submission received: 3 July 2025
/
Revised: 28 August 2025
/
Accepted: 17 September 2025
/
Published: 30 September 2025
Abstract
Background: Androgenetic alopecia (AGA) is the most prevalent form of hair loss in humans. Oral minoxidil and dutasteride are widely used treatments, while intradermal dutasteride mesotherapy has recently gained interest as a complementary approach. However, comparative studies in real-world settings are lacking. Objective: The aim was to compare the effectiveness and safety of four AGA therapies: oral minoxidil alone (OM), OM plus oral dutasteride (OM + OD), OM plus mesotherapy (OM + MD), and a combination of all three (CT). Methods: A retrospective study was conducted, including 280 adult patients (mean age 35 ± 9.4 years) with AGA, excluding those with recent treatment (last 3 months) or other hair loss disorders. The therapeutic response was assessed by comparing treatment outcomes from standardized clinical images at 6 and 12 months using a four-point improvement scale. Patient satisfaction was also assessed using a four-point subjective scale. Results: Participants were divided into four treatment groups. In total, 74 patients (26.4%) were treated with OM, 65 patients (23.2%) with OM + OD, 61 patients (21.8%) with OM + MD, and 80 patients (28.6%) with CT. At 12 months, group 4 treated with CT showed significantly better results in both frontal and vertex areas (p < 0.001), while group 3 (OM + MD) performed best at 6 months in the vertex. Side effects were mild and infrequent, with hypertrichosis being the most common. Erectile dysfunction was reported with a lower incidence than reported in the literature: two patients (3.1%) in group 2 (OM + OD) and three (3.8%) patients in CT. Overall, no serious adverse events were detected. Conclusions: Combining oral minoxidil, oral dutasteride, and mesotherapy with dutasteride yields the most effective results for AGA with a favorable safety profile.
1. Introduction
Androgenetic alopecia (AGA) is the most common form of hair loss in humans [1] and affects 80% of Caucasian men [2,3,4]. Oral minoxidil has been a game changer in the treatment of AGA over the past 5 years. It has been described that low-dose oral minoxidil (OM) is a safe and effective therapy for male patients with AGA [5,6]. Current data indicate that low-dose oral minoxidil (LDOM) with an average dose of 2.5 mg–5 mg has recently been described to be safe and effective [7,8].
The main physiopathology event in AGA is the conversion of hair from terminal to intermediate and vellus, a process known as miniaturization [9,10]. The miniaturization process is mediated by androgens in men [11]. Therefore, 5-AR inhibition (with dutasteride or finasteride) is the primary goal of AGA therapy [12]. Dutasteride is known to be superior to finasteride in the treatment of AGA [13]. It has recently been shown that the intermittent use of oral dutasteride in 0.5 mg capsules 2-3 times a week has greater effectiveness and a safety profile similar to that of oral finasteride [14,15]. Although stopping miniaturization is thought to be the most logical pathway in the treatment of AGA, patients do not want treatment with systemic 5-alpha-reductase enzyme inhibitors due to risk of sexual dysfunction (up to 4%) [16,17].
Mesotherapy or local intradermal therapy is a minimally invasive method that involves the injection of therapeutic agents such as drugs and bioactive substances into the skin at a depth of 2–4 mm [18,19]. One of the primary advantages of mesotherapy is that the therapeutic agent is administered directly into the skin, bypassing the barriers that would be faced by topical agents, thereby enabling a targeted approach to treatment [20]. As a result, it is hypothesized that the bioavailability of the agent is increased due to a longer residence time at the injected site, in addition to its direct presence in the targeted area [5,9]. Studies have proved mesotherapy with dutasteride microinjections an effective and safe alternative for men who refuse or cannot take oral 5-alpha reductase treatment [21].
To our knowledge, there are no studies comparing the effectiveness of the combination of oral minoxidil plus mesotherapy with dutasteride vs. oral minoxidil plus oral dutasteride in real clinical practice.
The objective of this article was to compare in real clinical practice the effectiveness and safety of oral minoxidil alone vs. oral minoxidil plus oral dutasteride vs. oral minoxidil plus mesotherapy with dutasteride vs. combined therapy with oral minoxidil plus systemic dutasteride plus mesotherapy with dutasteride for AGA.
2. Materials and Methods
A retrospective study was performed in patients with a confirmed diagnosis of AGA treated at CEDAVI Derma Experts, hair restoration unit, in San Pedro Garza Garcia, Mexico. A total of 280 patients completed the inclusion criteria: 74 (26.2%) patients were treated with only oral minoxidil (3.5 mg ± 1.58), 65 (23.2%) with oral minoxidil plus oral dutasteride (4.4 mg ± 1.11), 61 (21.8%) with oral minoxidil (4.35 mg ± 1.23) plus mesotherapy with dutasteride, and 80 (28.6%) patients with combined therapy with oral minoxidil (4.15 mg ± 1.25) plus oral dutasteride plus mesotherapy with dutasteride (Table 1). Inclusion criteria were adult male patient with a diagnosis of AGA; patients who underwent previous treatment for hair loss (last 3 months) and those with other causes of hair loss, or on hair loss therapy or who did not completed the protocol or did not have following pictures, were excluded from analysis.
Selected patients underwent a treatment with systemic oral minoxidil in a dose ranging from 1 to 5 mg oral minoxidil protocol for a 1-year follow-up period, and the clinical response was compared between the different treatment schemes for AGA.
The therapeutic response was assessed by comparing treatment outcomes from clinical images at 6 and 12 months shown in Appendix A Figure A1, evaluated by an independent dermatologist specialized in hair disorders. A 4-point scale (0 = no improvement, 1 = mild improvement, 2 = moderate improvement, or 3 = marked improvement, with marked improvement being a change of one grade in the Hamilton scale) was used to classify improvement in photography at 6 and 12 months in the frontal and vertex areas. Patient satisfaction was also assessed using a 4-point scale: 0, worsening; 1, stabilization; 2, mild improvement; and 3, marked improvement.
Mesotherapy with dutasteride was applied following regional ring block anesthesia. In total, 1mL of dutasteride (Duta ox, Dutasteride 0.01%, Maracay, Aragua, Venezuela was added to 1mL of physiologic solution in a 3 mL syringe; 2 mL of volume was then ready to be injected. The microinjections were performed by dividing the alopecic area into 2 cm intervals from each injection point, applied at a 90-degree angle with a 30 g × 4 mm needle (Missaga needle, Tokyo, Japan). This protocol was performed monthly for 3 months up to 12 months of treatment.
Statistical Analysis
Patient data were collected and analyzed using SPSS v.20 for Mac. For categorical variables, contingency and chi-square tables were used considering p < 0.05 as statistically significant.
3. Results
A total of 280 male patients (median age 33, 18–80) were included in this retrospective study. They were divided into four treatment groups: 74 (26.2%) patients were treated with only oral minoxidil (3.5 mg ± 1.58), 65 (23.2%) with oral minoxidil plus oral dutasteride (4.4 mg ± 1.11), 61 (21.8%) with oral minoxidil (4.35 mg ± 1.23) plus mesotherapy with dutasteride, and 80 (28.6%) patients with combined therapy with oral minoxidil (4.15 mg ± 1.25) plus oral dutasteride plus mesotherapy with dutasteride. The mean age of the patients was 34.99 ± 9.42 years.
3.1. Patient Self-Assessment Questionnaire Evaluation
Most patients experienced mild or excellent improvement at 6 months. However, when comparing the effectiveness of the treatment groups, there was no statistically significant difference (p < 0.07). In contrast, at 12 months OD + OM and OM + OD + MD showed significantly greater improvement compared to the other groups (p = 0.0001) (see Table 1).
3.2. Improvement in Photography in All Hamilton Groups
In the frontal area, most groups showed a good response to the treatments at 6 months, with no significant statistical difference (p = 0.101). At 12 months, group 4 (daily OM, mesotherapy, and oral dutasteride) exhibited a superior response compared to the other groups (p < 0.05) shown in Appendix A Figure A2. In the vertex area, most groups had a good response to the treatments at 6 months. However, group 3 (OM + MD) showed a superior response compared to the other treatment groups (p < 0.05) at 6 months. At 12 months, group 4 (OM + OD + MD) demonstrated a marked improvement compared to the other treatment groups (p < 0.05) (see Table 2).
Most of the patients (82.2%) did not report any side effects. Hypertrichosis was the most frequent side effect of the treatment groups (10.7%). A sexual adverse effect (erectile dysfunction) was found in two patients (3.1%) in OM + OD and three patients (3.8%) in the OM + OD + MD group. No sexual adverse effect was reported in the OM plus MD group. Only one patient suspended treatment due to edema in the combine therapy group; he was not included in the analysis. No serious adverse events were detected (see Table 3).
3.3. Sub-Analysis Comparing Results with Oral Minoxidil Dose
Improvement in Photography
A sub-analysis was conducted to assess the effectiveness of minoxidil based on dosage. The therapeutic response was evaluated by comparing treatment outcomes from clinical images at 6 and 12 months. In the frontal area, most groups exhibited a good response to treatment at 6 months, with no significant statistical difference (p = 0.109). However, at 12 months, the 5 mg OM group showed a superior response compared to the other groups (p < 0.05). In the vertex area, most groups showed a good response to treatment at 6 months; however, the 5 mg OM group demonstrated a slightly superior response compared to the other treatment groups (p < 0.003). At 12 months, the 5 mg OM group showed a marked improvement compared to the other treatment groups (p < 0.05) (see Table 4). It was found that patients taking 5 mg of OM daily had a significantly better response at 6 and 12 months (p < 0.05) (see Table 5).
3.4. Sub-Analysis Comparing Only Hamilton–Norwood III and IV
A sub-analysis was conducted to assess the effectiveness of treatment groups in patients who were classified as stage III and IV. In the frontal area, most groups exhibited a good clinical response to treatment at 6 months; however, there was no significant statistical difference (p = 0.058). However, at 12 months, group 4 showed a superior response compared to the other treatment groups (p < 0.05) (see Table 6).
Finally, a sub-analysis was conducted to assess the effectiveness of treatment groups in patients who were classified as stage III and IV. In the frontal area, most groups exhibited a good response to treatment at 6 months; however, there was no significant statistical difference (p = 0.071). However, at 12 months, group 4 (OM + OD + MD) showed a superior response compared to the other groups (p < 0.05). In the vertex area, most groups showed a good response to treatment at 6 months; however, group 3 (OM + MD) demonstrated a slightly superior response compared to the other treatment groups (p < 0.003). At 12 months, group 4 (OM + OD + MD) showed a marked improvement compared to the other treatment groups (p < 0.05) (see Table 7).
3.5. Safety
Most of the patients did not report side effects. Hypertrichosis was the most frequent side effect of the treatment groups. Erectile dysfunction was reported with a lower incidence than reported in the literature: two patients (3.1%) in group 2 (OM + OD) and three (3.8%) patients in CT. No patient in the OM + MD group reported sexual adverse effects. Overall, no serious adverse events were detected (see Table 3).
4. Discussion
The ideal treatment of androgenetic alopecia is one that acts on the different pathways of the physiopathology of AGA. On one hand, we need a 5-alpha-reductase enzyme inhibitor that stops miniaturization of the follicle, such as dutasteride [22,23], and on the other hand we need another such as minoxidil that promotes hair growth by increasing the duration of anagen, shortening telogen, and enlarging miniaturized follicles [24,25]. In an ideal world, combining these drugs must always be performed.
The average dose of dutasteride is 0.5 mg per day [26]. To achieve a stability in the blood, it takes 3–6 months (time to see clinical results), and to eliminate 50% of its dose it takes 3–5 weeks [27,28]. Although just a small percentage of patients have side effects due to dutasteride, the most common reason that patients do not want to be treated with anti-androgen treatments is sexual dysfunction, which is noted in up to 4% of patients [29,30].
Studies have shown that hair count and width increased dose-dependently with dutasteride [31]. Dutasteride 0.5 mg has been shown to significantly increase hair number and width/diameter in men with androgenetic alopecia and was relatively well tolerated with significantly increased thickness vs. finasteride at week 24 (p = 0.004) [32]. Shanshanwal et al. demonstrated that conversion from vellus hair to terminal hair occurred only with dutasteride therapy [18]. In our study, we decided to prescribe dutasteride 0.5 mg daily three times a week due to previously reported data.
Previously, the only up-to-date way to compare oral dutasteride vs. mesotherapy with dutasteride was with a meta-analysis comparing the hair density of different studies. In a larger meta-analysis, it was found that the mean change in hair count from baseline in cm2 was greater with oral dutasteride than with intralesional dutasteride (15.92 hairs/cm2, versus 7.9 hairs/cm2) [16]; no effects on libido with dutasteride mesotherapy have been reported, making it an ideal adjuvant therapy to increase results or an alternative for patients who do not want to undergo systemic therapy with dutasteride. In our study, at 12 months, the combined therapy group (OD, mesotherapy, and oral dutasteride) exhibited a superior response compared to the other groups (p < 0.05), reporting that 53 (66.3%) had an excellent outcome (Table 1). However, group 3 (oral minoxidil plus oral dutasteride) showed a superior response compared to the other treatment groups (p < 0.05) at 6 months. Since it is well known that the therapeutic effect of oral dutasteride takes around 6 months to be clinically seen, our hypothesis is that mesotherapy with dutasteride acts faster. We have previously reported good outcomes with mesotherapy with dutasteride in short periods of time (less than 6 months) [21]. Further studies are needed to prove this.
The overall incidence of AEs was similar between treatment groups, with no evidence of a dutasteride dose response. The most common side effect was hypertrichosis, with the oral minoxidil group reporting 13 patients (17.6%) and 11 (18%) in the oral minoxidil plus mesotherapy with dutasteride group (no statistical difference). There were no statistically significant differences between the four groups, and less than 4% of patients presented sexually adverse effects (Table 3), reporting fewer-than-expected side effects, as the literature has shown adverse events in 19 (7.6%) dutasteride-treated patients and 30 (10.5%) finasteride-treated patients, including sexual dysfunction [33]. There was no increase in sexual dysfunction in the combined group (oral minoxidil plus oral dutasteride plus mesotherapy with dutasteride), proving that a three-times-weekly dose is safe and effective.
In male AGA, Lueangarun et al. studied the use of a 5 mg daily dose [7]. Measured over 24 weeks, photographs showed 100% improvement, with 43% of men having “remarkable” improvement. With a longer duration of treatment, more patients showed remarkable improvement, as in our study (43–63% in all groups reported a great improvement, Table 1). Similarly, Jimenez-Cuahe et al. studied male AGA treated with a 5 mg or 2.5 mg daily dose. In a subgroup of patients treated with OM monotherapy, mostly at 5 mg, all showed clinical improvement, with 37.5% showing marked improvement [5]. In our study, all groups had oral minoxidil; however in the sub-analysis by daily dose of OM, we found a statistical significant difference in outcome at 6 and 12 months with a 5 mg daily dose of OM (p < 0.05), with a safety profile of adverse effects (Table 5).
It has been shown that up to 78% of patients continued oral therapy at last follow-up, demonstrating good compliance [24]. In our study, clinical and iconographic improvement was found in both groups, confirming the results previously described regarding the efficacy of oral minoxidil in AGA (Table 3). In the sub-analysis comparing the oral minoxidil dose, we found that 121 (64.4%) patients with the 5 mg dose of oral minoxidil had excellent improvement (p < 0.05, Table 5), confirming that results are dependent on the oral minoxidil dose.
The efficacy and safety of dutasteride have already been documented. An alternative to systemic dutasteride that has received growing interest recently is mesotherapy with dutasteride. Saceda-Corralo et al. MD described a protocol injecting 1 mL of intradermal dutasteride 0.01% over 6 months with a one-session treatment every 3 months, a total of three sessions. No adverse effects were recorded during the treatment sessions and follow-up period. Laboratory tests showed no differences between serum hormone levels before and after treatment [34]. Our study confirmed the efficacy of dutasteride mesotherapy for AGA. We found that in both groups (OM + mesotherapy and OM + mesotherapy and OD), 53 (66.3%) had an excellent improvement in the clinical scale (Table 1), and in the iconographic comparison 47 (58.8%) had a +2 improvement in the frontal area and 62 (77.5%) had a +2 improvement in the vertex area, making a statistical difference compared to other groups (Table 2).
Studies have reported that mesotherapy has the advantage that lower doses of drugs can be used with longer time intervals between sessions, which could lead to improved patient compliance [35,36]. Studies have shown that the administration of lower doses of approved and emerging agents through mesotherapy directly to the scalp may be an effective treatment for hair loss [37]. It is worth noting that no sexual dysfunction side effect was reported in our patients with mesotherapy, and it has been proven that there is no need to assess hormone levels as dutasteride mesotherapy does not affect androgens levels.
Our group had previously described that mesotherapy is a good alternative for patients who do not want or cannot take oral dutasteride [21]. Another advantage of mesotherapy is that patients taking oral dutasteride and MD concurrently can reduce oral dutasteride to 2–3 pills per week (a dose associated with greater tolerability and a lower incidence of side effects). Men can receive MD with treatment options other than oral 5-alpha reductase inhibitors (such as oral or topical minoxidil) [38].
The most common side effects of mesotherapy reported in the RCTs, observational studies, and prospective studies were mild and resolved in a few days. Headache, injection site pain, and scalp tightness or itching were most frequently reported, while some studies also mentioned redness and swelling [39]. Nine of the nineteen studies that observed hair regrowth did not report any adverse effects. Additional risk factors include drug–drug interactions, and possible product contaminations of injections are factors that can decrease the utility of mesotherapy. There were just few adverse effects overall, and it is worth nothing that none of them were a cause for discontinuation of the medication, as many patients considered them only mild side effects that were easily manageable, as has been reported among patients who used 5 mg daily [5,6].
Most of the patients did not report side effects; hypertrichosis was the most frequent side effect of the treatment groups. A sexual adverse (erectile dysfunction) effect was reported with a lower incidence than reported in the literature: two patients (3.1%): OM + OD; one patient (1.6%): OM + MD; and three patients (3.8%): OM + OD + MD (p = 0.184). Overall, no serious adverse events were detected (Table 3).
5. Conclusions
Combined therapy with oral minoxidil, oral dutasteride, and mesotherapy with dutasteride demonstrates highly favorable outcomes in the treatment of androgenetic alopecia AGA. The main advantages of combining the three therapies are that results are enhanced, the side effects that could occur with more frequency in the administration of oral dutasteride are lower, and patient adherence to treatment is overall good. Therapy with oral minoxidil and oral dutasteride is effective but not as effective as the combined therapy.
Finally, mesotherapy was proven to be effective as an adjuvant therapy but less effective than oral dutasteride but more effective than oral minoxidil alone, and it is ideal for those patients who are not candidates for systemic treatment with systemic anti-androgens (finasteride/dutasteride).
The limitations of this study include its retrospective design and the fact that it was conducted at a single center. However, it is noteworthy that the center is a specialized dermatological hair restoration clinic, which may enhance the clinical relevance of the findings. Additionally, TrichoScan evaluation and analysis were not performed due to the unavailability of this technology at our facility.
These results provide an opportunity to develop new treatment protocols for androgenetic alopecia.
Author Contributions
Conceptualization, C.D.V.-V. and D.S.-C.; methodology, E.B.-R. and S.V.-G.; software, J.F.M.-d.l.G.; formal analysis, C.D.V.-V., E.B.-R., C.G.-M., J.F.M.-d.l.G., D.S.-C. and S.V.-G.; writing—original draft preparation, C.D.V.-V., E.B.-R. and C.G.-M.; writing—review and editing, C.G.-M. and J.F.M.-d.l.G.; visualization, C.D.V.-V. and E.B.-R.; supervision, D.S.-C. and S.V.-G. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of University of Alcalá, protocol code DER AGA 01-2019 and approval date: 31 March 2019.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the patient(s) to publish this paper.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors on request.
Conflicts of Interest
The authors state no conflicts of interest.
Abbreviations
The following abbreviations are used in this manuscript:
| AGA | Androgenetic alopecia |
| OM | Oral minoxidil |
| OM + OD | Oral minoxidil plus oral dutasteride |
| OM + MD | Oral minoxidil plus mesotherapy |
| CT | Combination of all three: Oral minoxidil plus oral dutasteride plus mesotherapy |
| LDOM | Low-dose oral minoxidil |
Appendix A
Figure A1.
Representative examples showing the comparison of hair density outcomes between all groups. Patient (A) received oral minoxidil monotherapy (3.5mg ± 1.58). Patient (B) was treated with oral minoxidil plus oral dutasteride (4.4 mg ± 1.11). Patient (C) was treated with oral minoxidil (4.35 mg ± 1.23) plus mesotherapy with dutasteride. Patient (D) underwent combined therapy with oral minoxidil (4.15 mg ± 1.25) plus oral dutasteride plus mesotherapy with dutasteride. A total of 280 met the inclusion criteria: 74 (26.2%) patients were treated with only oral minoxidil (3.5 mg ± 1.58), 65 (23.2%) were treated with oral minoxidil plus oral dutasteride (4.4 mg ± 1.11), 61 (21.8%) were treated with oral minoxidil (4.35 mg ± 1.23) plus mesotherapy with dutasteride, and 80 (28.6%) patients underwent combined therapy with oral minoxidil (4.15 mg ± 1.25) plus oral dutasteride plus mesotherapy with dutasteride.
Figure A1.
Representative examples showing the comparison of hair density outcomes between all groups. Patient (A) received oral minoxidil monotherapy (3.5mg ± 1.58). Patient (B) was treated with oral minoxidil plus oral dutasteride (4.4 mg ± 1.11). Patient (C) was treated with oral minoxidil (4.35 mg ± 1.23) plus mesotherapy with dutasteride. Patient (D) underwent combined therapy with oral minoxidil (4.15 mg ± 1.25) plus oral dutasteride plus mesotherapy with dutasteride. A total of 280 met the inclusion criteria: 74 (26.2%) patients were treated with only oral minoxidil (3.5 mg ± 1.58), 65 (23.2%) were treated with oral minoxidil plus oral dutasteride (4.4 mg ± 1.11), 61 (21.8%) were treated with oral minoxidil (4.35 mg ± 1.23) plus mesotherapy with dutasteride, and 80 (28.6%) patients underwent combined therapy with oral minoxidil (4.15 mg ± 1.25) plus oral dutasteride plus mesotherapy with dutasteride.
Figure A2.
Outcome of a patient with combined therapy with OM + OD + MD. Combined therapy with oral minoxidil (4.15 mg ± 1.25), oral dutasteride, and mesotherapy with dutasteride.
Figure A2.
Outcome of a patient with combined therapy with OM + OD + MD. Combined therapy with oral minoxidil (4.15 mg ± 1.25), oral dutasteride, and mesotherapy with dutasteride.
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Table 1.
Patient self-assessment of the 4 groups.
| Oral Minoxidil, N = 74 | Oral Minoxidil + Oral Dutasteride, N = 65 | Oral Minoxidil + Dutasteride Mesotherapy, N = 61 | Oral Minoxidil + Oral Dutasteride + Dutasteride Mesotherapy, N = 80 | ||
|---|---|---|---|---|---|
| 6 months | 0.070 * | ||||
| Stabilization (1) | 6 (8.1%) | 0 (0%) | 4 (6.6%) | 0 (0%) | |
| Mild improvement (2) | 39 (52.7%) | 37 (56.9%) | 31 (50.8%) | 43 (53.8%) | |
| Excellent improvement (3) | 29 (39.2%) | 28 (43.1%) | 26 (42.6%) | 37 (46.2%) | |
| 12 months | 0.001 * | ||||
| Stabilization (1) | 2 (2.7%) | 0 (0%) | 2 (3.3%) | 0 (0%) | |
| Mild improvement (2) | 40 (54.1%) | 20 (30.8%) | 28 (45.9%) | 27 (33.8%) | |
| Excellent improvement (3) | 32 (43.2%) | 45 (69.2%) | 31 (50.8%) | 53 (66.3%) |
Androgenetic alopecia; Clinical response according to a 4-point scale: 0, worsening; 1, stabilization; 2, mild improvement; and 3, excellent improvement [5]. * Chi-square test.
Table 2.
Comparison of iconographic improvement comparing all Hamilton groups by dermatologist.
| Oral Minoxidil, N = 74 | Oral Minoxidil + Oral Dutasteride, N = 65 | Oral Minoxidil + Dutasteride Mesotherapy, N = 61 | Oral Minoxidil + Oral Dutasteride + Dutasteride Mesotherapy, N = 80 | ||
|---|---|---|---|---|---|
| 6 months | 0.101 | ||||
| No improvement | 3 (4.1%) | 2 (3.1%) | 1 (1.6%) | 0 (0%) | |
| +1 | 41 (55.4%) | 50 (76.9%) | 36 (59%) | 52 (65%) | |
| +2 | 28 (37.8%) | 13 (20%) | 22 (36.1%) | 28 (35%) | |
| +3 | 2 (2.7%) | 0 (0%) | 2 (3.3%) | 0 (0%) | |
| 12 months | 0.036 | ||||
| No improvement | 0 (0%) | 0 (0%) | 1 (1.6%) | 0 (0%) | |
| +1 | 42 (56.8%) | 35 (53.8%) | 39 (63.9%) | 33 (41.3%) | |
| +2 | 30 (40.5%) | 30 (46.2%) | 21 (34.4%) | 47 (58.8%) | |
| +3 | 2 (2.7%) | 0 (0%) | 0 (0%) | 0 (0%) | |
| Improvement in photography (vertex) | |||||
| 6 months | 0.000 | ||||
| No improvement | 9 (12.2%) | 2 (3.1%) | 2 (3.3%) | 0 (0%) | |
| +1 | 38 (51.4%) | 33 (50.8%) | 23 (37.7%) | 50 (62.5%) | |
| +2 | 26 (35.1%) | 30 (46.2%) | 31 (50.8%) | 30 (37.5%) | |
| +3 | 1 (1.4%) | 0 (0%) | 5 (8.2%) | 0 (0%) | |
| 12 months | 0.000 | ||||
| No improvement | 1 (1.4%) | 1 (1.5%) | 1 (1.6%) | 1 (1.3%) | |
| +1 | 43 (58.1%) | 20 (30.8%) | 27 (44.3%) | 15 (18.8%) | |
| +2 | 28 (37.8%) | 44 (67.7%) | 31 (50.8%) | 62 (77.5%) | |
| +3 | 2 (2.7%) | 0 (0%) | 2 (3.3%) | 2 (2.5%) |
A standardized 7-point rating scale (−3 to +3) was used, in which −3 indicates greatly decreased; −2, moderately decreased; −1, minimally decreased; 0, no change; +1, minimally increased; +2, moderately increased; and +3, greatly increased [7].
Table 3.
Adverse effects.
| Side Effects | Oral Minoxidil, N = 74 | Oral Minoxidil + Oral Dutasteride, N = 65 | Oral Minoxidil + Dutasteride Mesotherapy, N = 61 | Oral Minoxidil + Oral Dutasteride + Dutasteride Mesotherapy, N = 80 | p-Value |
|---|---|---|---|---|---|
| Tachycardia | 3 (4.1%) | 1 (1.5%) | 0 (0%) | 2 (2.5%) | 0.426 |
| Edema | 2 (2.7%) | 3 (4.6%) | 1 (1.6%) | 0 (0%) | 0.280 |
| Hypertrichosis | 13 (17.6%) | 2 (3.1%) | 11 (18%) | 4 (5%) | 0.003 |
| Hypotension | 0 (0%) | 0 (0%) | 1 (1.6%) | 0 (0%) | 0.308 |
| Trichomegaly | 0 (0%) | 2 (3.1%) | 0 (0%) | 0 (0%) | 0.083 |
| Erectile dysfunction | 0 (0%) | 2 (3.1%) | 0 (0%) | 3 (3.8%) | 0.184 |
Table 4.
Comparing efficacy with difference oral minoxidil dosages.
| Improvement in Photography (Frontal) | 1 mg, N = 18 | 2.5 mg, N = 74 | 5 mg, N = 188 | |
|---|---|---|---|---|
| 6 months | 0.109 | |||
| No improvement | 2 (11.1%) | 2 (2.7%) | 2 (1.1%) | |
| +1 | 10 (55.6%) | 52 (70.3%) | 117 (62.2%) | |
| +2 | 6 (33.3%) | 19 (25.7%) | 66 (35.1%) | |
| +3 | 0 (0%) | 1 (1.4%) | 3 (1.6%) | |
| 12 months | 0.003 | |||
| No improvement | 1 (5.6%) | 0 (0%) | 0 (0%) | |
| +1 | 12 (66.7%) | 44 (59.5%) | 93 (49.5%) | |
| +2 | 5 (27.8%) | 29 (39.2%) | 94 (50%) | |
| +3 | 0 (0%) | 0 (1.4%) | 2 (0.5%) | |
| Improvement in Photography (Vertex) | 1 mg, N = 18 | 2.5 mg, N = 74 | 5 mg, N = 188 | |
| 6 months | 0.028 | |||
| No improvement | 1 (5.6%) | 4 (5.4%) | 8 (4.3%) | |
| +1 | 10 (55.6%) | 50 (67.6%) | 84 (44.7%) | |
| +2 | 7 (38.9%) | 20 (27%) | 90 (47.9%) | |
| +3 | 0 (0%) | 0 (0%) | 6 (3.2%) | |
| 12 months | 0.080 | |||
| No improvement | 1 (5.6%) | 0 (0%) | 3 (1.6%) | |
| +1 | 8 (44.4%) | 37 (50%) | 60 (31.9%) | |
| +2 | 9 (50%) | 36 (48.6%) | 120 (63.8%) | |
| +3 | 0 (0%) | 1 (1.4%) | 5 (2.7%) |
A standardized 7-point rating scale (−3 to +3) was used, in which −3 indicates greatly decreased; −2, moderately decreased; −1, minimally decreased; 0, no change; +1, minimally increased; +2, moderately increased; and +3, greatly increased [7].
Table 5.
Analysis of patient self-assessment of the 4 groups depending on oral minoxidil dose.
| Clinical Improvement | 1 mg, N = 18 | 2.5 mg, N = 74 | 5 mg, N = 188 | |
|---|---|---|---|---|
| 6 months | 0.000 | |||
| Stabilization (1) | 3 (16.7%) | 3 (4.1%) | 4 (2.1%) | |
| Mild improvement (2) | 11 (61.1%) | 49 (66.2%) | 90 (47.9%) | |
| Excellent Improvement (3) | 4 (22.2%) | 22 (29.7%) | 94 (50%) | |
| 12 months | 0.004 | |||
| Stabilization (1) | 1 (5.6%) | 2 (2.7%) | 1 (0.5%) | |
| Mild improvement (2) | 12 (66.7%) | 37 (50%) | 66 (35.1%) | |
| Excellent improvement (3) | 5 (27.8%) | 35 (47.3%) | 121 (64.4%) |
Clinical response according to a 4-point scale: 0, worsening; 1, stabilization; 2, mild improvement; and 3, excellent improvement. An improvement of 1 grade or more on the Norwood–Hamilton scale was defined as marked improvement [5].
Table 6.
Patient self-assessment of the 4 groups only in Hamilton–Norwood patients grade III and IV.
Table 6.
Patient self-assessment of the 4 groups only in Hamilton–Norwood patients grade III and IV.
| Oral Minoxidil, N = 57 | Oral Minoxidil + Oral Dutasteride, N = 52 | Oral Minoxidil + Dutasteride Mesotherapy, N = 43 | Oral Minoxidil + Oral Dutasteride + Dutasteride Mesotherapy, N = 57 | ||
|---|---|---|---|---|---|
| 6 months | 0.058 | ||||
| Stabilization (1) | 6 (10.5%) | 0 (0%) | 4 (9.3%) | 0 (0%) | |
| Mild improvement (2) | 24 (42.1%) | 28 (53.8%) | 19 (44.2%) | 27 (47.4%) | |
| Excellent improvement (3) | 27 (47.4%) | 24 (46.2%) | 20 (46.5%) | 30 (52.6%) | |
| 12 months | 0.008 | ||||
| Stabilization (1) | 1 (1.8%) | 0 (0%) | 1 (2.3%) | 0 (0%) | |
| Mild improvement (2) | 28 (49.1%) | 14 (26.9%) | 19 (44.2%) | 11 (19.3%) | |
| Excellent improvement (3) | 28 (49.1%) | 38 (73.1%) | 23 (53.5%) | 46 (80.7%) |
Clinical response according to a 4-point scale: 0, worsening; 1, stabilization; 2, mild improvement; and 3, excellent improvement. An improvement of 1 grade or more on the Norwood–Hamilton scale was defined as marked improvement [5].
Table 7.
Comparison of iconographic improvement in Hamilton III and IV.
| Oral Minoxidil, N = 57 | Oral Minoxidil + Oral Dutasteride, N = 52 | Oral Minoxidil + Dutasteride Mesotherapy, N = 43 | Oral Minoxidil + Oral Dutasteride + Dutasteride Mesotherapy, N = 57 | ||
|---|---|---|---|---|---|
| Frontal | |||||
| 6 months | 0.071 | ||||
| No improvement | 2 (3.5%) | 2 (3.8%) | 0 (0%) | 0 (0%) | |
| +1 | 28 (49.1%) | 39 (75%) | 25 (58.1%) | 34 (59.6%) | |
| +2 | 25 (43.9%) | 11 (21.2%) | 16 (37.2%) | 23 (40.4%) | |
| +3 | 2 (3.5%) | 0 (0%) | 2 (4.7%) | 0 (0%) | |
| 12 months | 0.006 | ||||
| No improvement | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |
| +1 | 29 (50.9%) | 28 (53.8%) | 24 (55.8%) | 15 (26.3%) | |
| +2 | 26 (45.6%) | 24 (46.2%) | 19 (44.2%) | 42 (73.7%) | |
| +3 | 2 (3.5%) | 0 (0%) | 0 (0%) | 0 (0%) | |
| Vertex | |||||
| 6 months | 0.001 | ||||
| No improvement | 4 (7%) | 1 (1.9%) | 1 (2.3%) | 0 (0%) | |
| +1 | 31 (54.4%) | 26 (50%) | 11 (25.6%) | 30 (52.6%) | |
| +2 | 21 (36.8%) | 25 (48.1%) | 26 (60.5%) | 27 (47.4%) | |
| +3 | 1 (1.8%) | 0 (0%) | 5 (11.6%) | 0 (0%) | |
| 12 months | 0.000 | ||||
| No improvement | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |
| +1 | 32 (56.1%) | 14 (26.9%) | 19 (44.2%) | 5 (8.8%) | |
| +2 | 23 (40.4%) | 38 (73.1%) | 22 (51.2%) | 50 (87.7%) | |
| +3 | 2 (3.5%) | 0 (0%) | 2 (4.7%) | 2 (3.5%) |
A standardized 7-point rating scale (−3 to + 3) was used, in which −3 indicates greatly decreased; −2, moderately decreased; −1, minimally decreased; 0, no change; +1, minimally increased; +2, moderately increased; and +3, greatly increased [7].
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Villarreal-Villarreal, C.D.; Boland-Rodriguez, E.; Gonzalez-Macias, C.; Molina-de la Garza, J.F.; Saceda-Corralo, D.; Vano-Galvan, S. Effectiveness and Safety of Combined Therapy with Oral Minoxidil, Oral Dutasteride, and Mesotherapy with Dutasteride in Real Clinical Practice. J. Aesthetic Med. 2025, 1, 6. https://doi.org/10.3390/jaestheticmed1020006
AMA Style
Villarreal-Villarreal CD, Boland-Rodriguez E, Gonzalez-Macias C, Molina-de la Garza JF, Saceda-Corralo D, Vano-Galvan S. Effectiveness and Safety of Combined Therapy with Oral Minoxidil, Oral Dutasteride, and Mesotherapy with Dutasteride in Real Clinical Practice. Journal of Aesthetic Medicine. 2025; 1(2):6. https://doi.org/10.3390/jaestheticmed1020006
Chicago/Turabian StyleVillarreal-Villarreal, César Daniel, Estefanía Boland-Rodriguez, Carolina Gonzalez-Macias, Juan Francisco Molina-de la Garza, David Saceda-Corralo, and Sergio Vano-Galvan. 2025. "Effectiveness and Safety of Combined Therapy with Oral Minoxidil, Oral Dutasteride, and Mesotherapy with Dutasteride in Real Clinical Practice" Journal of Aesthetic Medicine 1, no. 2: 6. https://doi.org/10.3390/jaestheticmed1020006
APA StyleVillarreal-Villarreal, C. D., Boland-Rodriguez, E., Gonzalez-Macias, C., Molina-de la Garza, J. F., Saceda-Corralo, D., & Vano-Galvan, S. (2025). Effectiveness and Safety of Combined Therapy with Oral Minoxidil, Oral Dutasteride, and Mesotherapy with Dutasteride in Real Clinical Practice. Journal of Aesthetic Medicine, 1(2), 6. https://doi.org/10.3390/jaestheticmed1020006
